North Dakota

Behavioral Health Transformation

Pamela Sagness, Executive Policy Director

Department of Human Services

Behavioral health

Promoting

overall well-

being

Creating healthy

communities

Supporting

recovery

Preventing and

treating

substance use

disorder or

other addictions

Preventing and

treating

depression and

anxiety

A state of mental/emotional being and/or choices and actions that affect WELLNESS.

BEHAVIORAL HEALTH IS HEALTH

2014

Behavioral Health

Planning Final

Report

Schulte Consulting

2016

ND Behavioral

Health Assessment:

Gaps and

Recommendations

2018

ND Behavioral

Health System

Study

Human Services

Research Institute

(HSRI)

TIMELINE

North Dakota Behavioral Health System StudyApril 2018

“A well-functioning behavioral health system attends

not only to the intensive needs of children, youth, and

adults with serious mental health conditions and

substance use disorders but also to the outpatient

and community-based service and support needs of

individuals, and, critically, to the social and emotional

well-being of the majority of the population who have

not been diagnosed with a behavioral health

condition—especially children, youth, and young

adults.”

6

North Dakota Behavioral Health System StudyRECOMMENDATIONS

The 250-page report provides more than 65 recommendations in 13 categories.

1. Develop a comprehensive implementation plan

2. Invest in prevention and early intervention

3. Ensure all North Dakotans have timely access to behavioral health services

4. Expand outpatient and community-based service array

5. Enhance and streamline system of care for children and youth

6. Continue to implement/refine criminal justice strategy

7. Engage in targeted efforts to recruit/retain competent behavioral health workforce

8. Expand the use of tele-behavioral health

9. Ensure the system reflects its values of person-centeredness, cultural competence, trauma-informed approaches

10. Encourage and support the efforts of communities to promote high-quality services

11. Partner with tribal nations to increase health equity

12. Diversify and enhance funding for behavioral health

13. Conduct ongoing, system-side data-driven monitoring of needs and access

7

For more information about BH in

ND visit:

https://www.hsri.org/NDvision-2020

8

Residential and inpatient expenditures accounted for about 85% of substance use disorder treatment services in FY2017.

Youth SUD

Outpatient 1%

Adult SUD

Outpatient 14%

SUD

Residential

78%

SUD Inpatient

7%

Total estimated substance use disorder treatment expenditures were $19 million

9

Residential, inpatient, and long-term care facility services accounted for a majority of mental health system treatment service expenditures in FY2017.

10

Institute of Medicine Continuum of Care

Behavioral Health Continuum of Care ModelThe goal of this model is to ensure there is access to a full range of high quality

services to meet the various needs of North Dakotans.

11

LANGUAGE

MATTERS

EDUCATION

Multi-tiered System of

Support (MTSS)

BEHAVIORAL

HEALTH

Continuum of Care

Behavioral

Health

Special

Education

Special

Education

Behavioral

Health

Need

WHO DECIDES THE WHY?

Behavioral

Health

Professionals

Special

Education

Professionals

Keys to Reforming North Dakota’s Behavioral Health System

Support the full

Continuum of Care

Increase

Community-Based

Services

Prevent Criminal

Justice Involvement

for Individuals with

a Behavioral Health

Condition

20

Behavioral Health Priorities Department of Human Services Budget SB 2012

SB 2012

SECTIONPROGRAM/SERVICE DIVISION BUDGET

1

Substance Use Disorder Voucher (additional dollars to support need, additional capacity [2 FTE], and

reduction in age eligibility from 18 to 14; previously SB 2175)Behavioral Health Division

Parents Lead Behavioral Health Division

Mental Illness Prevention (previously 2028) Behavioral Health Division

Recovery home grant program Behavioral Health Division

Maintain trauma-informed practices network (funding moved from SB 2291) Behavioral Health Division

Suicide prevention transfer from Department of Health Behavioral Health Division

Statewide Behavioral Health Crisis Services Field Services Division

4 Peer Support certification (previously SB 2032) Behavioral Health Division

5 Community Behavioral Health Program (expansion of Free Through Recovery; previously SB 2029) Behavioral Health Division

18 IMD, Bed Capacity, and Medicaid waiver (1115) Study Field Services Division

21 School Behavioral Health Grants (previously 2300) Behavioral Health Division

22 School Behavioral Health Program Behavioral Health Division

38 Expansion of Targeted Case Management – youth with SED (previously 2031) Medical Services

39 Expansion of Targeted Case Management – adults with SMI (previously 2031) Medical Services

40 Withdrawal management coverage in Medicaid Medical Services

41 1915i Medicaid State Plan Amendment (adults and youth [previously 2298]) Medical Services

45 Sustain HSRI Behavioral Health Study Implementation support (previously SB 2030) Behavioral Health Division

Other Behavioral Health-Related Bills

House Bill 1103

Opioid Treatment Medication Units

PASSED Passed House (13-0-1) (87-3)

Passed Senate (6-0-0) (44-0)

50-31-01"Medication unit" means a facility established as part of,

but geographically separate from, an opioid treatment

program, from which a licensed practitioner dispenses or

administers an opioid treatment medication or collects

samples for drug testing or analysis.

House Bill 1105Voluntary Treatment Program and SUD Voucher

PASSED Passed House (12-0-2) (87-1)

Passed Senate (6-0) (45-0)

50-06-06.13.

…The department may establish a program to prevent out-

of-home placement for a Medicaid eligible child with a

behavior health condition as defined in the "Diagnostic and

Statistical Manual of Mental Disorders", American

psychiatric association, fifth edition, text revision (2013).

50-06-42.

…assist in the payment of addiction treatment services

provided by private licensed substance abuse treatment

programs, excluding regional human service centers, and

hospital-or medical clinic-based programs for medical

management of withdrawal.

Senate Bill 2149

Behavioral Health Resource Coordinators

PASSED Passed Senate (7-0) (44-3)

Passed House (14-0) (86-4)

15.1-07-34

Youth behavioral health training to teachers, administrators,

and ancillary staff.

…Each school within a district shall designate an

individual as a behavioral health resource coordinator.

…The superintendent of public instruction shall maintain the

contact information of the behavioral health resource

coordinator in each school.

Senate Bill 2313

Children’s System of Services and Cabinet

PASSED Passed Senate (5-0-1) (44-0)

Passed House (14-0) (81-9)

50-06-05.1

To develop a system of services and supports to provide behavioral

health services and supports in the community for children at risk of or

identified as having a behavioral health condition and for the families of

these children.

To provide resources on mental health awareness and suicide

prevention to the behavioral health resource coordinator at each

school. The resources must include information on identifying warning

signs, risk factors, and the availability of resources in the community.

Senate Bill 2313

Children’s System of Services and Cabinet

PASSED Passed Senate (5-0-1) (44-0)

Passed House (14-0) (81-9)

50-06

Children's cabinet - The children's cabinet is created to assess, guide, and

coordinate the care for children across the state's branches of government and

the tribal nations.

50-06

Commission on Juvenile Justice – will review chapter 27-20; gather

information concerning issues of child welfare, including education, abuse and

neglect; Receive reports and testimony in furtherance of the commission's

duties; Advise effective intervention, resources, and services for children;

Report to and be subject to the oversight of the children's cabinet; and

Annually submit to the governor and the legislative management a report

with the commission's findings and recommendations which may include a

legislative strategy to implement the recommendations.